Aripiprazole
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Trade Name
Abilify (primary brand name); also generic aripiprazole. Variants include Abilify Maintena (long-acting injection)
Classification
Atypical antipsychotic; second-generation antipsychotic (SGA)
Dosage/Route
- * Dosage:
- – Tablets: 2 mg, 5 mg, 10 mg, 15 mg, 20 mg, 30 mg
- – Oral solution: 1 mg/mL.
- – Injection (IM): 9.75 mg/1.3 mL (acute); 400 mg (Maintena, monthly)
- * Route: Oral (PO), intramuscular (IM)
Usual Dosage
- * Schizophrenia: 10-15 mg PO once daily; max 30 mg/day
- * Bipolar I (Mania): 15 mg PO once daily; may adjust to 30 mg/day
- * Depression (adjunct): 2-5 mg PO daily; max 15 mg/day
- * IM (acute agitation): 5.25-9.75 mg single dose
- * Maintena (maintenance): 400 mg IM every 4 weeks (after oral stabilization)
Mechanism of Action
Acts as a partial agonist at dopamine D2 and serotonin 5-HT1A receptors, and an antagonist at 5-HT2A receptors. This stabilizes dopamine and serotonin activity, reducing psychotic symptoms and mood instability with less extrapyramidal side effect (EPS) risk than typical antipsychotics
Side Effects & Adverse Effects
- * Side Effects: Headache, insomnia, anxiety, nausea, akathisia (restlessness)
- * Adverse Effects:
- – Neuroleptic malignant syndrome (NMS) (rare; fever, rigidity, altered mental status)
- – Tardive dyskinesia (TD) (late-onset, involuntary movements)
- – Weight gain, diabetes risk, orthostatic hypotension
- – Suicidal thoughts (esp. in young patients)
Nursing Management (Implications & Teachings)
- * Implications:
- – Monitor for EPS (akathisia, dystonia), NMS (vital signs, muscle rigidity), and TD (AIMS scale).
- – Assess weight, glucose, lipids (metabolic syndrome risk).
- – Watch for suicidality, especially early in treatment or dose changes.
- * Teachings:
- – Take at the same time daily; with/without food.
- – Avoid alcohol (worsens sedation/CNS effects).
- – Report fever, muscle stiffness, restlessness, or unusual movements.
- – Rise slowly to prevent dizziness (orthostasis).
- – Adherence critical—don’t stop abruptly.
Indication for This Patient
- * Schizophrenia: Manage positive/negative symptoms
- * Bipolar I Disorder: Acute mania or maintenance
- * Major Depressive Disorder: Adjunct to antidepressants
- * Irritability in autism (pediatric); acute agitation (IM)
Time
- * Timing: PO: Once daily (any time, but consistent); IM Maintena: every 4 weeks.
- * Onset: Therapeutic effect for psychosis/mood in 1-2 weeks; full benefit may take 4-6 weeks.
- * IM (agitation): Calming effect in hours
